المؤلفون: David M Maahs, Ashby F Walker, Michael J Haller, Matthew J Gurka, Stephanie L Filipp, Claudia Anez-Zabala, Xanadu Roque, Lauren Figg, Rayhan Lal, Ananta Addala, Melanie Hechavarria

المصدر: BMJ Open, Vol 13, Iss 8 (2023)

مصطلحات موضوعية: Medicine

الوصف: Objectives Individuals under-recruited in diabetes research studies include those not seen at endocrinology centres and those from rural, low socioeconomic and/or under-represented racial/ethnic groups. The purpose of this descriptive analysis is to detail recruitment and retention efforts of Project ECHO Diabetes clinical sites affiliated with Stanford University and University of Florida.Design Prospective collection of participant engagement and qualitative analysis of barriers and facilitators of research engagement within Project ECHO Diabetes, a virtual tele-education programme for healthcare providers in the management of individuals with insulin-requiring diabetes.Setting Data were collected at the patient level, provider level and clinic level between 1 May 2021 and 31 July 2022.Participants Participants and study personnel were recruited from 33 Project ECHO Diabetes sites in California and Florida.Outcomes We report study completion rates for participants recruited into 33 Project ECHO Diabetes sites. Using barrier analysis, a methodology designed for the real-time assessment of interventions and system processes to identify barriers and facilitators, study personnel identified significant barriers to recruitment and retention and mapped them to actionable solutions.Results In total, 872 participants (California n=495, Florida n=377) were recruited with differing recruitment rates by site (California=52.7%, Florida=21.5%). Barrier analysis identified lack of trust, unreliable contact information, communication issues and institutional review board (IRB) requirements as key recruitment barriers. Culturally congruent staff, community health centre (CHC) support, adequate funding and consent process flexibility were solutions to address recruitment challenges. Barriers to retention were inconsistent postal access, haemoglobin A1c kit collection challenges, COVID-19 pandemic and broadband/connectivity issues. Additional funding supporting research staff and analogue communication methods were identified as solutions address barriers to retention.Conclusions Funded partnerships with CHCs, trusted by their local communities, were key in our recruitment and retention strategies. IRB consent process flexibility reduced barriers to recruitment. Recruiting historically under-represented populations is feasible with funding aimed to address structural barriers to research participation.

وصف الملف: electronic resource

العلاقة: https://bmjopen.bmj.com/content/13/8/e072546.fullTest; https://doaj.org/toc/2044-6055Test

الوصول الحر: https://doaj.org/article/85b7437ead76465ba63aa5f427f50461Test

المؤلفون: David M Maahs, Angelina Bernier, Ashby F Walker, Nicolas Cuttriss, Michael J Haller, Korey K Hood, Matthew J Gurka, Stephanie L Filipp, Claudia Anez-Zabala, Katarina Yabut, Xanadu Roque, Jessie J Wong, Linda Baer, Lauren Figg, Sarah Westen, Eugene Lewit, Eleni Sheehan, Marina Basina, Rayhan Lal, Jennifer Maizel

المصدر: BMJ Open Diabetes Research & Care, Vol 9, Iss 1 (2021)

مصطلحات موضوعية: Diseases of the endocrine glands. Clinical endocrinology, RC648-665

الوصف: Introduction Project ECHO (Extension for Community Healthcare Outcomes) is a tele-education outreach model that seeks to democratize specialty knowledge to reduce disparities and improve health outcomes. Limited utilization of endocrinologists forces many primary care providers (PCPs) to care for patients with type 1 diabetes (T1D) without specialty support. Accordingly, an ECHO T1D program was developed and piloted in Florida and California. Our goal was to demonstrate the feasibility of an ECHO program focused on T1D and improve PCPs’ abilities to manage patients with T1D.Research design and methods Health centers (ie, spokes) were recruited into the ECHO T1D pilot through an innovative approach, focusing on Federally Qualified Health Centers and through identification of high-need catchment areas using the Neighborhood Deprivation Index and provider geocoding. Participating spokes received weekly tele-education provided by the University of Florida and Stanford University hub specialty team through virtual ECHO clinics, real-time support with complex T1D medical decision-making, access to a diabetes support coach, and access to an online repository of diabetes care resources. Participating PCPs completed pre/post-tests assessing diabetes knowledge and confidence and an exit survey gleaning feedback about overall ECHO T1D program experiences.Results In Florida, 12 spoke sites enrolled with 67 clinics serving >1000 patients with T1D. In California, 11 spoke sites enrolled with 37 clinics serving >900 patients with T1D. During the 6-month intervention, 27 tele-education clinics were offered and n=70 PCPs (22 from Florida, 48 from California) from participating spoke sites completed pre/post-test surveys assessing diabetes care knowledge and confidence in diabetes care. There was statistically significant improvement in diabetes knowledge (p≤0.01) as well as in diabetes confidence (p≤0.01).Conclusions The ECHO T1D pilot demonstrated proof of concept for a T1D-specific ECHO program and represents a viable model to reach medically underserved communities which do not use specialists.

وصف الملف: electronic resource

العلاقة: https://drc.bmj.com/content/9/1/e002262.fullTest; https://doaj.org/toc/2052-4897Test

الوصول الحر: https://doaj.org/article/ce45ca63dc854703b5f3d2bda7159564Test

المؤلفون: Brittany S Bruggeman, Heather K Vincent, Xiaofei Chi, Stephanie L Filipp, Rebeccah Mercado, François Modave, Yi Guo, Matthew J Gurka, Angelina Bernier

المصدر: PLoS ONE, Vol 15, Iss 9, p e0238863 (2020)

مصطلحات موضوعية: Medicine, Science

الوصف: A progressive, treadmill-based VO2max is the gold standard of cardiorespiratory fitness determination but is rarely used in pediatric clinics due to time requirements and cost. Simpler and shorter fitness tests such as the Squat Test or Step Test may be feasible and clinically useful alternatives. However, performance comparisons of these tests to treadmill VO2max tests are lacking. The primary aim of this cross-sectional study was to assess the correlation between Squat and Step Test scores and VO2max in a pediatric population. As secondary outcomes, we calculated correlations between Rated Perceived Exertion Scale (RPE) scores, NIH PROMIS Physical Activity scores, and BMI z-score with VO2max, and we also evaluated the ability of each fitness test to discriminate low and high-risk patients based on the FITNESSGram. Forty children aged 10-17 completed these simple cardiorespiratory fitness tests. Statistically significant correlations were observed between VO2max and the Step Test (r = -0.549) and Squat Test (r = -0.429) scores, as well as participant BMI z-score (r = -0.458). RPE and PROMIS scores were not observed to be correlated with VO2max. Area Under the Receiver Operator Curve was relatively high for BMI z-scores and the Step Test (AUC = 0.813, 0.713 respectively), and lower for the Squat Test (AUC = 0.610) in discriminating risk according to FITNESSGram Scores. In this sample, the Step Test performed best overall. These tests were safe, feasible, and may add great value in assessing cardiorespiratory fitness in a clinical setting.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1932-6203Test

الوصول الحر: https://doaj.org/article/6221924d8da242d19a0a61e00c08d844Test

المؤلفون: Fatima S. Hussain, Aniruddh Setya, Isaac Molina, Naueen A. Chaudhry, Xiaofei Chi, Matthew J. Gurka, Stephanie L. Filipp, Angela Pham, David Kerman, Maria T. Abreu, Ellen M. Zimmermann

المصدر: Gastro Hep Advances, Vol 2, Iss 7, Pp 928-934 (2023)

مصطلحات موضوعية: College students, Access to healthcare, Biologics, Antidepressants, Narcotics, Diseases of the digestive system. Gastroenterology, RC799-869

الوصف: Background and Aims: Late adolescents and young adults (AYA) with inflammatory bowel disease (IBD) are a vulnerable population as they transition to adult healthcare. We aim to provide a real-world data on their healthcare utilization patterns and medication use through a large database. Methods: We performed a retrospective cohort study from January 1, 2012, to June 30, 2020, using OneFlorida Data-Trust, an electronic health record-based data repository representing over half of the Florida population. Outcomes of interest included demographics, healthcare utilization, medications, and disease severity. Chi-square tests and logistic regression were used to compare the rates of medication use, healthcare utilization, and disease severity by age groups. Results: The number of patients who met our inclusion criteria was 10,578 with 2731 (25.8%) in the 17–25-year-old group. AYA patients had fewer ambulatory visits vs children (90% vs 95%; P value <.05). AYA patients were admitted more frequently from emergency facilities vs children (22.3% vs 10.9%; P value <.05). AYA patients received steroids more often than adults and younger patients (48.9% vs 45.3 vs 44.3% P value <.05, respectively). AYA patients received more narcotic (41.1% vs 22.3 % P value <.05) and antidepressant prescriptions (15.9% vs 9.5%; P value <.05) compared with children. With advancing age, a decrease in biologic use was noted (51% vs 40% vs 25.4% P value <.05, respectively). Conclusion: AYA patients with IBD have higher rates of hospital admissions from emergency department, fewer ambulatory health visits and they receive more steroids compared to children. Our study demonstrates the need for age-specific IBD programs for AYA patients.

العلاقة: http://www.sciencedirect.com/science/article/pii/S277257232300095XTest; https://doaj.org/toc/2772-5723Test; https://doaj.org/article/ce1d384f086a4e55917b927a91bfbe52Test

الإتاحة: https://doi.org/10.1016/j.gastha.2023.06.009Test
https://doaj.org/article/ce1d384f086a4e55917b927a91bfbe52Test

المؤلفون: Ananta Addala, Stephanie L. Filipp, Lauren E. Figg, Claudia Anez-Zabala, Rayhan A. Lal, Matthew J. Gurka, Michael J. Haller, David M. Maahs, Ashby F. Walker, for the Project ECHO Diabetes Research Team, Michael Haller, Eleni Sheehan, Angelina Bernier, Sarah Westen, Hannah Stahmer, William Troy Donahoo, Xanadu Roque, Gabby Malden, Melanie Hechavarria, David Maahs, Rayhan Lal, Lauren Figg, Katarina Yabut, Noor Alramahi, Ana Cortes, Dessi Zaharieva, Marina Basina, Katie Judge, Lety Wilke, Korey Hood, Jessie Wong, Jason Wang, Suruchi Bhatia, Eugene Lewit

المصدر: Frontiers in Endocrinology, Vol 13 (2022)

مصطلحات موضوعية: equity, primary care provider education, disparities, health, type 1 diabetes, tele-education, Diseases of the endocrine glands. Clinical endocrinology, RC648-665

الوصف: IntroductionIn the US, many individuals with diabetes do not have consistent access to endocrinologists and therefore rely on primary care providers (PCPs) for their diabetes management. Project ECHO (Extension for Community Healthcare Outcomes) Diabetes, a tele-education model, was developed to empower PCPs to independently manage diabetes, including education on diabetes technology initiation and use, to bridge disparities in diabetes.MethodsPCPs (n=116) who participated in Project ECHO Diabetes and completed pre- and post-intervention surveys were included in this analysis. The survey was administered in California and Florida to participating PCPs via REDCap and paper surveys. This survey aimed to evaluate practice demographics, protocols with adult and pediatric T1D management, challenges, resources, and provider knowledge and confidence in diabetes management. Differences and statistical significance in pre- and post-intervention responses were evaluated via McNemar’s tests.ResultsPCPs reported improvement in all domains of diabetes education and management. From baseline, PCPs reported improvement in their confidence to serve as the T1D provider for their community (pre vs post: 43.8% vs 68.8%, p=0.005), manage insulin therapy (pre vs post: 62.8% vs 84.3%, p=0.002), and identify symptoms of diabetes distress (pre vs post: 62.8% vs 84.3%, p=0.002) post-intervention. Compared to pre-intervention, providers reported significant improvement in their confidence in all aspects of diabetes technology including prescribing technology (41.2% vs 68.6%, p=0.001), managing insulin pumps (41.2% vs 68.6%, p=0.001) and hybrid closed loop (10.2% vs 26.5%, p=0.033), and interpreting sensor data (41.2% vs 68.6%, p=0.001) post-intervention.DiscussionPCPs who participated in Project ECHO Diabetes reported increased confidence in diabetes management, with notable improvement in their ability to prescribe, manage, and troubleshoot diabetes technology. These data support the use of tele-education of PCPs to increase confidence ...

العلاقة: https://www.frontiersin.org/articles/10.3389/fendo.2022.1066521/fullTest; https://doaj.org/toc/1664-2392Test; https://doaj.org/article/1a5a25ac84384bc4a54d00c751d57234Test

الإتاحة: https://doi.org/10.3389/fendo.2022.1066521Test
https://doaj.org/article/1a5a25ac84384bc4a54d00c751d57234Test

المؤلفون: Brittany S. Bruggeman, Martha Campbell-Thompson, Stephanie L. Filipp, Matthew J. Gurka, Mark A. Atkinson, Desmond A. Schatz, Laura M. Jacobsen

المصدر: Frontiers in Endocrinology, Vol 12 (2021)

مصطلحات موضوعية: islet amyloid polypeptide, islets of langerhans, pancreatitis, pathology, substance-related disorders, tissue donors, Diseases of the endocrine glands. Clinical endocrinology, RC648-665

الوصف: Access to human pancreas samples from organ donors has greatly advanced our understanding of type 1 diabetes pathogenesis; however, previous studies have shown that donors have a high rate of substance use, and its impact on pancreatic histopathology in this disease is not well described. One-hundred-thirty-one type 1 diabetes and 111 control organ donor pancreata from persons 12-89 years of age (mean 29.8 ± 15.5 years) within the Network for Pancreatic Organ donors with Diabetes (nPOD) were examined for insulin positivity, insulitis, amyloid staining, acute and chronic pancreatitis, and chronic exocrine changes (acinar atrophy, fibrosis, fatty infiltration, or periductal fibrosis); findings were compared by history of substance use. A secondary analysis compared exocrine pancreatic histopathologic findings in type 1 diabetes versus control organ donors regardless of substance use history. We observed a high but congruent rate of substance use in type 1 diabetes and control organ donors (66.4% and 64% respectively). Among donors with type 1 diabetes (but not controls), islet amyloid (OR 9.96 [1.22, 81.29]) and acute pancreatitis (OR 3.2 [1.06, 9.63]) were more common in alcohol users while chronic exocrine changes (OR 8.86 [1.13, 69.31]) were more common in cocaine users. Substance use impacted the pancreata of donors with type 1 diabetes more than controls. Overall, despite similar rates of substance use, acute pancreatitis (15.3% versus 4.5%, p=0.0061), chronic pancreatitis (29.8% versus 9.9%, p=0.0001), and chronic exocrine changes (73.3% versus 36.9%, p<0.0001) were more common in type 1 diabetes donors than controls. Alcohol and/or cocaine use in type 1 diabetes organ donors increases exocrine pancreas pathology and islet amyloid deposition but does not affect insulitis or insulin positivity. Exocrine pathology in type 1 diabetes donors is common, and further study of the pathophysiology of these changes is needed.

العلاقة: https://www.frontiersin.org/articles/10.3389/fendo.2021.778912/fullTest; https://doaj.org/toc/1664-2392Test; https://doaj.org/article/9fcb09c6bd724f0792d6b2f5202af3feTest

الإتاحة: https://doi.org/10.3389/fendo.2021.778912Test
https://doaj.org/article/9fcb09c6bd724f0792d6b2f5202af3feTest

المؤلفون: Lindsay A. Thompson, Matthew J. Gurka, Stephanie L. Filipp, Desmond A. Schatz, Rebeccah E. Mercado, David A. Ostrov, Mark A. Atkinson, Sonja A. Rasmussen

المصدر: EClinicalMedicine, Vol 37, Iss , Pp 100936- (2021)

مصطلحات موضوعية: Observational study, Selection bias, COVID-19, SARS-CoV-2, Medicine (General), R5-920

الوصف: Background: Medications to prevent and treat SARS-CoV-2 infection are needed to complement emerging vaccinations. Recent in vitro and electronic health record (EHR) studies suggested that certain allergy medications could prevent SARS-CoV-2 infection. We sought to carefully examine the potential selection bias associated with utilizing EHRs in these settings. Methods: We analyzed associations of three allergy medications (cetirizine, diphenhydramine or hydroxyzine) with testing negative for SARS-CoV-2, measuring the potential effect of selection bias on these associations. We used a retrospective cohort of EHR data from 230,376 patients (18 years+) who visited outpatient clinicians in a single, large academic center at least once but were never hospitalized (10/1/2019–6/1/2020). Main exposures included EHR documentation of three allergy medications and allergy, with an intermediate outcome of receipt of a SARS-CoV-2 test, and the primary outcome as testing negative. Findings: SARS-CoV-2 testing rates varied by sex, age, race/ethnicity and insurance. Increasing age and public insurance were associated with a higher adjusted odds of test negativity, while being Black or Hispanic was significantly associated with test positivity. Allergy diagnosis and use of any of three allergy medications were each associated with a higher likelihood of receiving a test (e.g. diphenhydramine - Odds Ratio (OR) 2.99, 95% Confidence Interval (CI) 2.73, 3.28; cetirizine 1.75 (95% CI 1.60, 1.92)). Among those tested, only use of diphenhydramine was associated with a negative SARS-CoV-2 test (adjusted OR = 2.23, 95% CI 1.10, 4.55). However, analyses revealed that selection bias may be responsible for the apparent protective effect of diphenhydramine. Interpretation: Diphenhydramine use was associated with more SARS-CoV-2 testing and subsequent higher odds for negative tests. While EHR-based observational studies can inform a need for interventional trials, this study revealed limitations of EHR data. The finding that diphenhydramine ...

العلاقة: http://www.sciencedirect.com/science/article/pii/S2589537021002169Test; https://doaj.org/toc/2589-5370Test; https://doaj.org/article/8d8887f14197490090d9d2d36d21f7e9Test

الإتاحة: https://doi.org/10.1016/j.eclinm.2021.100936Test
https://doaj.org/article/8d8887f14197490090d9d2d36d21f7e9Test

المؤلفون: Jennifer M. Loso BS, Stephanie L. Filipp MPH, Matthew J. Gurka PhD, Michael K. Davis MD

المصدر: Global Pediatric Health, Vol 8 (2021)

مصطلحات موضوعية: Pediatrics, RJ1-570

الوصف: Increased waiting time in pediatric emergency departments is a well-recognized and complex problem in a resource-limited US health care system. Efforts to reduce emergency department wait times include modeling arrival rates, acuity, process flow, and human resource requirements. The aim of this study was to investigate queue theory and load-leveling principles to model arrival rates and to identify a simple metric for assisting with determination of optimal physical space and human resource requirements. We discovered that pediatric emergency department arrival rates vary based on time of day, day of the week, and month of the year in a predictable pattern and that the hourly change in pediatric emergency department waiting room census may be useful as a simple metric to identify target times for shifting resources to better match supply and demand at no additional cost.

العلاقة: https://doi.org/10.1177/2333794X20944665Test; https://doaj.org/toc/2333-794XTest; https://doaj.org/article/15925e4bd43e41cdb442825c7f949594Test

الإتاحة: https://doi.org/10.1177/2333794X20944665Test
https://doaj.org/article/15925e4bd43e41cdb442825c7f949594Test

المؤلفون: Stephanie A.S. Staras, Susan T. Vadaparampil, Lindsay A. Thompson, Courtney Scherr, Matthew J. Gurka, Stephanie L. Filipp, Elizabeth A. Shenkman

المصدر: Preventive Medicine Reports, Vol 20, Iss , Pp 101188- (2020)

مصطلحات موضوعية: Preventative care, Provider recommendation, Reminder, Vaccine, Human papillomavirus, Medicine

الوصف: Parent-targeted reminders increase human papillomavirus (HPV) vaccination rates. Our postcard reminders increased HPV vaccine initiation (receipt of at least one dose) by 60% among girls, but not substantially among boys. To select a complementary intervention that would maximize the effect of reminders, we assessed the percentage increase in HPV vaccine initiation from reminders increasing preventive care visits or increasing the likelihood of vaccine receipt during preventive care.We conducted a secondary analysis of the postcard reminders from a quasi-experimental, factorial designed, feasibility trial conducted in 2013–2014 among 2,470 11- to 17-year-old girls enrolled in Florida’s Medicaid or Children’s Health Insurance Programs. We used log-linear models and a 4-way decomposition method to estimate the mediating and interacting effects of preventive visits on the effect of postcards on HPV vaccination.After receiving a preventive visit, 76% (269/356) of girls remained unvaccinated. Nearly half of the effect of postcards on HPV vaccination was mediated by preventive visits (44%; 95% CI = 9.2% to 78.0%). Postcards increased HPV vaccine initiation mainly by increasing the likelihood of HPV vaccine receipt during preventive visits (pure indirect effect = 32.3%; 95% CI = 1.5% to 63.1%), and also by increasing the occurrence of preventive visits (mediated interaction = 11.3%; 95% CI = 1.5 to 21.1).Reminders likely increased vaccination rates during well visits by priming parents for HPV vaccine conversations with their child’s health care provider. Thus, reminder effectiveness may be increased if timed closely to preventive care visits and/or combined with interventions that improve provider recommendations.Trial Registration: ClinicalTrials.gov, NCT04208269, Registered 23, December 2019 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04208269Test.

العلاقة: http://www.sciencedirect.com/science/article/pii/S2211335520301479Test; https://doaj.org/toc/2211-3355Test; https://doaj.org/article/77480d4184f045bbaa8bd0b96c84702dTest

الإتاحة: https://doi.org/10.1016/j.pmedr.2020.101188Test
https://doaj.org/article/77480d4184f045bbaa8bd0b96c84702dTest

المؤلفون: Rachel A. Reedy PAC, Stephanie L. Filipp MPH, Matthew J. Gurka PhD, Archana Shenoy MD, Michael K. Davis MD, MBA

المصدر: Global Pediatric Health, Vol 6 (2019)

مصطلحات موضوعية: Pediatrics, RJ1-570

الوصف: Esophagogastroduodenoscopy (EGD) is commonly performed for abdominal pain in children, and in the presence of alarm symptoms, the diagnostic yield of this procedure is high. The aim of this study was to investigate the utility of EGD when performed for uncomplicated abdominal pain in children in the absence of alarm symptoms. Charts of all children less than 18 years of age who underwent EGD at the University of Florida between January 2016 and October 2018 were reviewed. Of 1478 children who underwent EGD for any indication, 287 patients (male-to-female = 123:164) were discovered to have undergone EGD, in the absence of colonoscopy, for uncomplicated acute or chronic abdominal pain, nausea, vomiting, gastroesophageal reflux, and/or dyspepsia, with no alarm symptoms. A significant change in clinical management was noted in 20 (7.0%) children. The findings of this procedure changed clinical management in a minority of our study participants.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2333-794XTest

الوصول الحر: https://doaj.org/article/40cd1a183a8749d89fb3df1069b7e5d6Test